Provider Demographics
NPI:1356555494
Name:ASHURST, SHAN W (LPN)
Entity type:Individual
Prefix:MS
First Name:SHAN
Middle Name:W
Last Name:ASHURST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PRINCE GEORGE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-4271
Mailing Address - Country:US
Mailing Address - Phone:317-883-3030
Mailing Address - Fax:
Practice Address - Street 1:108 PRINCE GEORGE CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-4271
Practice Address - Country:US
Practice Address - Phone:317-883-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27014770A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse